Children's Ministry Liability Form

As of April 2016, parents are required to fill out this form for every child who attends special Children's Ministry events when the parent will be dropping off their children. Once this form has been filled out, it does not need to be filled out again, unless your information has changed.
Children's Ministry Liability Form

Child's home address*


Please fill out the following information for the parent/guardian.

( )   -

If there is more than one parent/guardian in the household, please fill out Parent/Guardian #2 section below

( )   -

Please fill out the information below for an emergency contact other than the parent(s)/guardian(s).

( )   -

( )   -

Please list people besides parents who are authorized to pick up your child from KHC CM Events. Please include a contact number. We will ask to see identification from anyone not in possession of the child's claim ticket.

The overseeing Pastor/Leader is responsible for maintaining such behavior in the group, and has authority to direct offenders to be picked up by their parent/guardian. The parent/guardian will bear all expenses for picking up their child. Behavior that is not tolerated includes, but may not be limited to:

  • Fighting, harassment, continued coarse speech or behavior
  • Possession of any weapon or dangerous object
  • Possession of tobacco, alcohol, or controlled substances
  • Males are not allowed in females’ rooms and females are not allowed in males’ rooms at anytime
  • No one is to stray from the group. In the event that someone becomes separated by accident, they must make every effort to immediately rejoin the group
  • Respect for and compliance for event/facility rules 

* Safe and moral conduct is mandatory for every participant at every event.

As the Parent/Legal Guardian of (child listed above), I authorize King’s Harbor Church, into whose care the minor has been entrusted, to consent to medical or dental treatment and/or care under Section 6910 of the California Family Code. It is understood that this authorization is given in advance of any specific diagnosis or treatment being required, and is given to provide authority and power to render care which the aforementioned physician, in his or her best judgment may deem advisable.

As parent/legal guardian of (child listed above) I have reviewed the information about Children’s Ministry/activity event and give my permission for the subject of this release to be involved in the overall activities listed above. I acknowledge that my child’s participation in King’s Harbor Church Children’s Ministry is voluntary and may require involvement in events that require traveling or physical exertion. I acknowledge that his/her participation in any King’s Harbor Church Children’s Ministry event presents risks that my child may suffer property damage, bodily injury, or death.   

I/we have reviewed the rules of the activity and agree that the subject of this release will abide by them.   I/we also acknowledge that if the subject of this release has to return home early for any discipline violations it will be at my/our expense.     

I/we consent to the use of any video images, photographs, audio recordings or any visual or audio reproduction that may be taken of the subject of this release during the activity/event to be used, distributed or shown as King’s Harbor Church deems appropriate. 

I/we understand all reasonable safety precautions will be taken at all times by King’s Harbor Church and its agents during the events and activities.  I/we understand the possibilities of unforeseen hazards and know the inherent possibility of risk.  I/we agree to hold harmless King’s Harbor Church, its leaders, employees and volunteer staff for damages losses, diseases or injuries incurred by the subject of this release.  

My child has permission to attend all church sponsored Children’s Ministry events, including, but not limited to the following list:

Christmas Musical, Children’s Choir, Movie Night, Kids’ Night Out, Vacation Bible School, Summer Art Camp, etc.

NOTE: If you desire to limit your participation in any event, please put your restrictions to King’s Harbor Church in writing in advance of the event.

The undersigned has read and voluntarily signed this release and waiver of liability and indemnity agreement, and further agrees that no oral representation, statements or inducement apart from the foregoing written agreement have been made.